Hematology/ Oncology

Credits: 4.00 CREDITS (Clinical Elective)
Sites: DFCI, BWH
Directors: Mayer, Robert James
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time for one month. Not offered July and August.
Open to Exclerks: US/Canadian
This course represents an introduction to medical oncology and clinical hematology with an emphasis on the broad areas of diagnosis and treatment of neoplastic disease. The four week block is divided into two sections; a two week experience as part of the inpatient hematology consultation team at the Brigham and Women’s Hospital with each team consisting of an Attending Physician, one or two fellows, and an occasional medical resident; and a two week experience in ambulatory oncology with each student assigned to a first year medical oncology fellow whom he/she accompanies through the outpatient disease centers at the Dana-Farber Cancer Institute (e.g. Breast Oncology Center, Hematologic Malignancies, etc.), assessing patients in all of these centers along with an Attending Physician. Students are exposed to the multidisciplinary approach to the management of patients with neoplastic disease. Students attend such weekly conferences as “Fellows Report”, Hematology/Oncology Grand Rounds, a fellow-oriented research conference, pathology conference, and “New Patient Conference”. Additionally, students are encouraged to attend weekly patient-oriented conferences held by the benign hematology, breast oncology, gastrointestinal oncology, hematologic malignancy, and thoracic oncology groups. Additional lectures and conferences in basic, health services, clinical, and bioethical areas are open to student participation.
Learning Goals:
Students are oriented by the Course Director on the first day of the rotation and told that the primary goal of the experience will be an exposure to a wide variety of hematologic and oncologic disorders, an appreciation of how experienced physicians manage the emotional as well as the purely medical aspects of these disorders, and an opportunity to participate in consultations both on an inpatient and outpatient basis for individuals with newly diagnosed hematologic and malignant conditions.
Students will have an opportunity to learn how to interpret peripheral blood smears and bone marrow aspirations and also will observe how combination chemotherapy is administered to patients – primarily in the ambulatory setting.
Students will be exposed to the use of clinical trials in the management of patients with hematology and oncologic conditions and will be directed to evidence-based literature that provides the foundation and justification for such efforts. Additionally, students will be encouraged to obtain and analyze appropriate medical literature related to the patients they are seeing.
Students will be given the opportunity of presenting a patient to the Attending Physicians and fellows at the weekly “New Patient Conference” at which time a 15-20 minutes PowerPoint discussion based on a literature review regarding some aspect of diagnosis and/or management will be offered.
Incorporation of Basic Science Content and Evidence-Based Medicine:
Decisions in the management of oncology patients is primarily based on the outcome of clinical trials which assess the efficacy and tolerance of potential therapeutic interventions. Inherent in such therapeutic decision making are concerns regarding toxicity and cost. Students will be exposed, at multiple weekly conferences, to discussions related to the cellular/molecular basis for a given therapy, the translational data to support its use, and the evidence that it has been shown to benefit patients. These issues – the mechanism of action and the evidence of efficacy for treatment – permeate conferences and clinic discussions on a daily basis
Students are evaluated by the Course Director, the Attending Physician on the Benign Hematology Service, oncology Attending Physicians who have interacted with the student, and each fellow who has worked with a given student. Additionally, the presentation at the weekly “New Patient Conference” is assessed by the Course Director, by Dr. Richard Stone, and other faculty members. Each of these individuals is asked to submit an HMS grading sheet; the Course Director collates these opinions and produces a final evaluation form.
Grade Criteria:
High Honors:
Students receiving High Honors are expected to demonstrate a superior fund of medical knowledge including a “grounding” in the basic mechanisms of hematology and oncology, to read widely during the course of the rotation, to be proficient at such skills as history-taking and physical examination, to be able to formulate clinical and laboratory data into a concisely organized oral presentation, to relate humanistically and confidently with patients and their families and also to work well with the “care team”. Students receiving High Honors are also expected to present a thoughtful, well-organized case presentation with appropriate literature citations at the weekly “New Patient Conference”.
Students receiving honors are expected to show an interest in hematology and oncology, to demonstrate knowledge of basic mechanisms and clinical diseases, to attend and participate in rounds and teaching conferences, to be knowledgeable of the status of patients whom they have evaluated, to be able to present patient-related information in an intelligible manner, to relate humanistically to patients and their families, and to relate well to the medical care team. Students receiving honors are expected to give a thoughtful presentation on a clinical topic with evidence of exposure to the medical literature
Students receiving a satisfactory grade are expected to attend conferences and teaching rounds on a regular basis, demonstrate an adequate understanding of the disease processes under discussion, interact in a respectful manner with patients and their families, and show some ability integrating clinical and laboratory information into an oral presentation. Students who do not prepare a case presentation with a literature review for the weekly “New Patient Conference” but fulfill other requirements for the rotation, are generally given a grade of Satisfactory.
Students who are given a grade of Unsatisfactory are those whose attendance at rounds and conferences is erratic, individuals whose understanding of disease processes is extremely superficial, those who interact poorly with patients and their families as well as the medical care team, and those who are unable to integrate clinical and laboratory data into an oral presentation.
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